Healthcare Provider Details

I. General information

NPI: 1730710781
Provider Name (Legal Business Name): ANDREW BODKIN SMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD STE B103
WEST SENECA NY
14224-2655
US

IV. Provider business mailing address

550 ORCHARD PARK RD STE A105
WEST SENECA NY
14224-2654
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-5005
  • Fax: 716-712-0160
Mailing address:
  • Phone: 716-677-6000
  • Fax: 716-677-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number716953
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: